Insurance doublecross!! I AM SICK!!

I work for a hospital that was recently taken over by another hospital system. Our insurance changed to the same insurance that this other hospital has. Different group numbers though. I called my insurance about 2 months ago and was told that this surgery is covered. I called back several weeks later to ask another question and was again told yes, it is covered. I called again Friday to check on something else and was told, wait, we told you wrong! Your insurance does NOT cover this surgery! I am livid! I am just 2 days away from seeing my PCP for the last time for the required 2 medically supervised diets. He will be ready to send in his recommendation letter. And now this. I am so terribly crushed. We do not have anything in writing, no booklet or anything about our insurance. The only thing I know to do is to go to HR on Tuesday and ask to see a copy of the main policy. Surely they have to have something on file. Also, I remember the date of the second call I made to the ins co, and the name of the lady I spoke to. I am not sure of the date of the first call but I feel like it was the same person. To all of you out there, please please please document everything. I don't know what to do next. If there is an exclusion in my policy (after I see the master policy, if I get to), I intend to see if Gary can "Git r done". And what if HR tells me they have nothing to show me? Am I supposed to just take their word for it that WLS is not covered? I want proof. The hospital who now is managing us has the same insurance and their insurance covers WLS. In fact their website is where I found the info about the WLS seminar I went to. My surgeon works out of this other hospital. But we have a different group #. Baloney. I have spent so long believing I was going to have this surgery and now.....I feel like crying yet again.

You have a good cry and then dry your eyes and fight them Go to your HR and ask to see the booklet. Your insurance sounded like my husbands. Like I tell everyone. ALWAYS ask for EVERYTHING in writing from the insurance company and for now on get everything in writing if you must fight them. Keep your head up and fight for your rights. I was told also by my husbands company that they don't cover WLS. I got it Donna 338/219 -119

Thank you so much for your encouraging words, Donna. The clincher that got me was your last sentence "I got it" !!! I am going to fight them like a pit bull! They will want to give me this surgery on a silver platter before I am through with them! I just don't understand why these insurance companies don't just see the light. Why in the world don't they realize that if they let us have the surgery, they save money in the long run. All they seem to care about is the here and now. I guess they too realize that there are not too many obese elderly people in the rest homes. I never see an obese elderly person in my hospital. Well, if they think this MO is going to just croak and go away they have got another thing coming. And if I don't get just the right answer from HR, I am calling GARY!!!!!!

Good for you. Yes call Gary and see what he has to say. He won't do you wrong When my husbands insurance was giving me the run around and I wanted a booklet on what was covered I called my husbands HR and we got on the phone with someone at BCBS and that's when I was told that my husbands company stopped covering WLS back in 2001. I said well excuse me but I have it in writing that they DO cover it. She said they won't cover it and I did worry myself to death at first but then it dawned on me. Why would the insurance company put money out on all these tests for me to get ready for WLS if they did not cover it. I got every Doctor I saw to write a letter on behalf stating that I needed the surgery and they sent it to my surgeon. Good luck and don't give up. That's what these insurance companies want is for you stick your tail between your legs and walk away. Donna

OOPS! Did not finish this "Your insurance sounded like my husbands" I meant to say my husbands insurance NEVER provided us with a booklet either.

What insurance company do you have? Maybe there are others on here that have the same company and have gotten approved that can add some input. You may want to post this on the main board also.

I have Memorial Hermann Freedom of Choice. And I have posted before and on the main board begging for someone with this same insurance. But no one ever responded. Would love to talk to someone who has this ins.

Does your insurance company have a website you can go to and download a copy of your policy? You may be able to enter your group or policy # and get a copy that way. Hang in there!! Michelle